AHA/ACC Guidelines (2007) – Perioperative Cardiovascular ...
AHA/ACC Guidelines (2007) – Perioperative Cardiovascular Evaluation of the Patient undergoing Non-cardiac Surgery
Take Home Message = if assessment and evaluation not indicated irrespective of perioperative context then just crack on.
3 factors involved in risk stratification:
1. Patient risk factors (high, intermediate and low risk)
2. Functional capacity (>4 METS = low, 170)
- DM (on insulin)
Risk of Perioperative Cardiac Events (AMI, APO, CVA, arrhythmia, death)
0 factors = 0.4%
1 = 1%
2 = 6.6%
3-5 = 11%
MINOR RISK FACTORS
- advanced age
- abnormal ECG
- arrhythmia
- low functional capacity
- previous CVA
- uncontrolled HT
Functional Capacity
1 MET = personal cares
2 METS = walk indoors
3 METS = walk a block on level ground, dusting and washing dishes
4 METS = climb a flight of stairs or walk up hill
5 METS = run a short distance
6 METS = scrubbing floors or lifting heavy objects
7-9 METS = golf, bowling, dancing, doubles tennis, throwing rugby ball
>10 METS = swimming, singles tennis, basketball, skiing
Surgery
HIGH RISK (>5%)
- major emergency surgery
- aortic or major open vascular surgery
INTERMEDIATE RISK (1-5%)
- intraperitoneal and intrathoracic surgery
- carotid endarterectomy
- head and neck surgery
- orthopaedic surgery
- prostate surgery
LOW RISK ( delay surgery 2-4 weeks and keep anti-platelet agents going
- bare metal stent -> delay surgery 4-6 weeks (will be on clopidogrel for this time too)
- drug eluting stents -> delay surgery for 12 months (will be on dual platelet therapy), if patients must undergo therapy keep aspirin going and restart clopidogrel as soon as possible
Perioperative management of patients with prior PCI
- see above time frames (4 weeks, 6 weeks & 12 months)
- try and keep dual anti-platelet therapy going
- if can’t keep aspirin going and reinstitute clopidogrel as soon as possible
- there is no evidence that other agents decrease risk of stent thrombosis
Perioperative management of patients who have received intracoronary brachytherapy
- gamma or beta brachytherapy used to treat recurrent in-stent restenosis
- continue anti-platelet agents if possible
Perioperative management of the patient who requires PCI and surgery soon after
- use same time lines based on when surgery indicated
- 4 weeks -> balloon
- 6 weeks -> bare metal stent
- 12 months -> drug eluting stent
- can put stents in and then deal with restenosis if it takes place
- also CABG + non-cardiac surgery an option
Perioperative Beta-blockers
- aim = to decrease perioperative MI and death
- should start weeks prior to surgery
- use longer acting agents
- aim for a HR turn off their tachyarrhythmia treatment algorithms, place defibrillation paddles far away from device (AP ideal)
Otherwise standard care
POSTOPERATIVE
- monitor clinically for MI
- if develops PCI needs to considered in context of bleeding risk
- manage acutely with early consultation with cardiology
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- aha acc guidelines 2007 perioperative cardiovascular
- adopted clinical practice and preventive health guidelines
- acc aha guidelines for the management of patients with
- β blockers in heart failure pharmacy benefit management
- what is cardiac rehabilitation
- acc aha guidelines for ambulatory electrocardiography
Related searches
- acc aha stemi guidelines 2017
- acc aha hypertension guidelines 2019
- acc aha stemi guidelines 2019
- acc aha stemi guidelines 2018
- acc aha hypertension guidelines 2020
- aha acc nstemi guidelines 2017
- aha acc guidelines stemi
- aha acc guidelines 2017
- acc aha htn guidelines 2017
- acc aha hypertension guidelines pdf
- acc aha stroke guidelines 2018
- acc aha stemi guidelines 2013